Elizabeth McMillan Green Malone, D.M.D.
Individual provider Active NPI General Practice Dentistry · Lyman, SC
NPI 1114289345 · NPPES record last updated Jun 13, 2012
Key facts
- NPI
- 1114289345
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 8072 (SC)
- Practice address
- 206 Elliott Rd
Lyman, SC 29365-1620 - Phone
- (864) 439-6559
- Fax
- (864) 439-1905
- NPI assigned
- Jun 13, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150715001701 | SC | Order and Referring Only - Dentist |
7113230400 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8072 | SC | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Foothills Family Dental PA | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8072 | SC | Yes |
Addresses
Primary practice location
206 Elliott Rd
Lyman, SC 29365-1620
Mailing address
206 Elliott Rd
Lyman, SC 29365-1620
Phone (864) 439-6559
Other providers in Lyman, SC
- Kirk E Houston DMD PA
- Gary Allen Lee
- Lyman Dental Associates PC
- Lyman Drug, Inc.
- Lyman Family Dentistry, LLC
- William Malone
- Medix Transportation LLC
- Middle Tyger Community Center
- Middle Tyger Community Center
- Arlene Minguez-Finizia
All providers in Lyman, SC · General Practice Dentistry in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.